Compensation decrease

[Attending1985]

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I just got my reconciliation from last year and my rvu rate went down 8 dollars. I was told new cms schedules and cms increasing it decreased the rvu rate. So I saw more patients this year but made less money. Can’t believe they’re doing this.

 

[hamstergang]

cms increasing it decreased the rvu rate

Can you explain what this part means? Also, did you get paid less than the previous year, or are you saying you just got paid less per RVU?

 

[Attending1985]

Can you explain what this part means? Also, did you get paid less than the previous year, or are you saying you just got paid less per RVU?

I was told since Rvu values per code increased the rvu value had to decrease to compensate. Yes I got paid less than previous year despite seeing more patients. I’m salary plus bonus so my bonus this year was essentially nothing.

 

[PsyDr]

The "conversion factor" went down by $1.55 in 2023. The conversion factor is set to go down another $1.15 next year.

https://www.psychiatry.org/getattachment/33c95719-10d3-423d-a49d-353a0c5b7f5b/APA-Letter-CMS-2024-Medicare-PFS-QPP-Response-09112023.pdf

 

[smalltownpsych]

I was told since Rvu values per code increased the rvu value had to decrease to compensate. Yes I got paid less than previous year despite seeing more patients. I’m salary plus bonus so my bonus this year was essentially nothing.

Reminds me of when I was in sales and they would roll out new bonus packages that reduced our pay and they would tell us how great the new package was. One reason I left the business world is because that is where you find some of the sleaziest people rising to the top. Don’t worry, their compensation won’t decrease.

 

[Attending1985]

Reminds me of when I was in sales and they would roll out new bonus packages that reduced our pay and they would tell us how great the new package was. One reason I left the business world is because that is where you find some of the sleaziest people rising to the top. Don’t worry, their compensation won’t decrease.

I just can’t believe they’re reducing pay year to year. It’s really demoralizing.

 

[Sushirolls]

Don't forget Bidenomics and inflation. That's even worse to your financial bottom line.
And if Kamala has her way I read some headline about taxing Unrealized gains! Then when the economy crashes as result of the ripple effect from such a law; Money will simply = food.

@Attending1985 Its real simple - shut up and put up, or tell the Big Box shop to pound sand and reach for something better.

*But I do feel your pain, I was seeing such things unfold at a Big Box shop I worked at years ago, demoralizing, left, eventually settled in PP.
**Those CMS decreases don't translate to $8/wRVU reduction even if the Big Box shop has 2/3 medicare. No good "crisis" goes to waste.

 

[Attending1985]

Don't forget Bidenomics and inflation. That's even worse to your financial bottom line.
And if Kamala has her way I read some headline about taxing Unrealized gains! Then when the economy crashes as result of the ripple effect from such a law; Money will simply = food.

@Attending1985 Its real simple - shut up and put up, or tell the Big Box shop to pound sand and reach for something better.

*But I do feel your pain, I was seeing such things unfold at a Big Box shop I worked at years ago, demoralizing, left, eventually settled in PP.

Yeah you’re right guess I’ve got some choices to make … when they do stuff like this you wonder if they actually want you to quit

 

[Sushirolls]

They don't care. If you quit, its an opportunity to infill with an ARNP. If you stay, they saved money. It is a win win for them.

 

[Merovinge]

Yeah you’re right guess I’ve got some choices to make … when they do stuff like this you wonder if they actually want you to quit

If you are seeing more patients and getting paid less (which is actually almost comical btw), it is very clearly a play to say we keep only the best lapdogs on staff OR the practice was paying out above market rate before and they are trying to get things in-line.

It is not as though psychiatry salaries are going down year over year (they continue to go up!)

 

[Attending1985]

They don't care. If you quit, it’s an opportunity to infill with an ARNP. If you stay, they saved money. It is a win win for them.

True. Really makes me regret going into medicine.

 

[Attending1985]

If you are seeing more patients and getting paid less (which is actually almost comical btw), it is very clearly a play to say we keep only the best lapdogs on staff OR the practice was paying out above market rate before and they are trying to get things in-line.

It is not as though psychiatry salaries are going down year over year (they continue to go up!)

what is the average rvu for psych in the Midwest? Not sure where they are in the market

 

[jbomba]

True. Really makes me regret going into medicine.

This regret should be directed at corporate medicine rather than medicine in general..some are making money hand over fist. But they aren't employees of a big box.

 

[calvnandhobbs68]

Don't forget Bidenomics and inflation. That's even worse to your financial bottom line.
And if Kamala has her way I read some headline about taxing Unrealized gains! Then when the economy crashes as result of the ripple effect from such a law; Money will simply = food.

remember that one time when we talked about if you were so concerned about certain political ideologies being “discriminated” against you shouldn’t randomly insert inflammatory political content for no reason….

 

[Sushirolls]

Declining pay hurts.
Inflation is real, and actively underway. It hurts purchasing power and one's livelihood.
Talking points with current politicians can become real policies.
A real threat, is something such taxing unrealized gains, which could gut the entire retirement system.
Currently we have limited number of boomers and other generations financially prepared to embark into retirement with quality or even a glint of financial security.
Now, even considering or talking about taxing unrealized gains, would diminish retirement accounts even further. Diminish investment accounts, some people have those as an element of their retirement, too. Depending on how this policy is implemented or defined, it could even mean homes - the main investment for most people - image also getting taxed increased home valuations. The shear volume of ripples this would have in so many sectors of the economy is mind boggling. These points are all connected, and not just a random political insert. The grand theme, of decreased income directly, and other indirect means (inflation, government policy).

The previous thread was a simple query, are conservative student and residents discriminated against. That was it. Even a simple thread as that couldn't go unaccosted by vitriol of liberal posts.

My comments are a counter balance to heavy over vocalization of liberal views. If you'd like, I can use your label of "Inflammatory political content" each time I spot the similar on SDN from the majority opinions?

Or perhaps, you could educate me on the unrealized gains tax policy, and respond this way:
Yo Sushi. Definitely, face value, looks atrocious. But digging into the weed and details of what's proposed it might have merits as it would work like XYZ, and impact ABC. The ripple would be minimal. And likely not generate as much tax to make a government impact. But certainly is a good talking point in this political season to drum up more liberal support. Got to give cackling Kamala some credit there. So as of right now, thankfully, the odds of a greater US economic collapse are quite low, and we won't have to be worrying about the calculus of can we simply buy food. But can you imagine if Trump is able to cut taxes more with existing government expenditures how much that will drive up the national debt and possibly force an economic collapse with Greek level austerity measures in coming decades. Yikes!

Nah, I'll try to be civil and address the points in threads for the value of their ideas, and not attack the posters.

 

[Sushirolls]

Yeah you’re right guess I’ve got some choices to make … when they do stuff like this you wonder if they actually want you to quit

Another tactic used, is increasing the wRVUs threshold to hit base pay. So it then starts to look, that if you take any vacation you never hit RVU thresholds.

Another trick, if you fall under a certain wRVUs threshold. Let's use arbitrary numbers. You need to hit 100 per month to get paid $1000 per month base salary. But if you get 89 wRVUs in month, they decrease the conversion factor from $10 per wRVU to $7 wRVU.

 

[clozareal]

Now, even considering or talking about taxing unrealized gains, would diminish retirement accounts even further. Diminish investment accounts, some people have those as an element of their retirement, too. Depending on how this policy is implemented or defined, it could even mean homes - the main investment for most people - image also getting taxed increased home valuations. The shear volume of ripples this would have in so many sectors of the economy is mind boggling. These points are all connected, and not just a random political insert. The grand theme, of decreased income directly, and other indirect means (inflation, government policy).

You keep mentioning this taxing unrealized gains but the proposal was on any assets above $100M.

 

[Sushirolls]

@calvnandhobbs68 See how @clozareal just diminished that element of my post as not a concern? In one sentence. Did so with out attacking the poster.

Well done @clozareal
Simple, to the point.

 

[splik]

I sympathize they pulled this BS on me when I was in academics. It’s all lies - the whole point of the increased RVUs was to reflect the work done by physicians in cognitive specialties and mental health professions not to feather the nests of corporate executives. Not everywhere pulls this but it is common. I would be looking at your options because it is unacceptable. The medicare conversion factor decreases are totally irrelevant to wRVU based compensation which is mostly from commercial insurance.

 

[Attending1985]

I sympathize they pulled this BS on me when I was in academics. It’s all lies - the whole point of the increased RVUs was to reflect the work done by physicians in cognitive specialties and mental health professions not to feather the nests of corporate executives. Not everywhere pulls this but it is common. I would be looking at your options because it is unacceptable. The medicare conversion factor decreases are totally irrelevant to wRVU based compensation which is mostly from commercial insurance.

Thanks. I just don’t see any better options in my location. Might need to consider telemedicine.

 

[clozareal]

@calvnandhobbs68 See how @clozareal just diminished that element of my post as not a concern? In one sentence. Did so with out attacking the poster.

Well done @clozareal
Simple, to the point.

Personal attacks are unnecessary and don't add to the discussion which this forum is meant to foster. I would much rather debate the merits of a particular argument or topic than to judge or be judged based on my personality.

I don't know @Sushirolls personally, but I have been helped tremendously by many of his posts, despite me disagreeing with his opinions on many occasion.

 

[PsyDr]

Anyone that is legitimately worried about capital gains taxes, is doing it VERY wrong. There are many tax advantaged vehicles out there. I would urge everyone to educate yourself about finances. If you're feeling more aggressive, OLD surgeons have the hookups. There is a reason that the rich use FLPs, Incs, multi-tiered LLCs, family home offices, etc.

 

[finalpsychyear]

True. Really makes me regret going into medicine.

Yup the only field where you have to work harder and see more patients to make the same non inflation adjusted pay. I feel your pain. Im working more hours just to be in the same range as before. I'm not even going to go into the inflation adjusted amounts its sadly less even if you count the higher hours. The only solution is to invest heavy a la white coat live like a resident mentality and then the nest egg you accumulate along the way should at least keep up with inflation and then some.

It never made sense why the salaries i see aren't that much better since 2016 when i was looking and no where close to inflation adjusted.
My 2 cents is keep the gig if its going good and map out your end game out of medicine may up the savings or investing for a few years.

 

[finalpsychyear]

Anyone that is legitimately worried about capital gains taxes, is doing it VERY wrong. There are many tax advantaged vehicles out there. I would urge everyone to educate yourself about finances. If you're feeling more aggressive, OLD surgeons have the hookups. There is a reason that the rich use FLPs, Incs, multi-tiered LLCs, family home offices, etc.

Yes but most aren't self employed to take advantage of DB, 401k, hsa let alone the higher level vehicles you have posted. Old surgeons were making 7 figs and the smart ones kept a lot of it due to what you mentioned albeit with a much higher irs audit risk back then let alone now going forward.

 

[Attending1985]

Yup the only field where you have to work harder and see more patients to make the same non inflation adjusted pay. I feel your pain. Im working more hours just to be in the same range as before. I'm not even going to go into the inflation adjusted amounts its sadly less even if you count the higher hours. The only solution is to invest heavy a la white coat live like a resident mentality and then the nest egg you accumulate along the way should at least keep up with inflation and then some.

It never made sense why the salaries i see aren't that much better since 2016 when i was looking and no where close to inflation adjusted.
My 2 cents is keep the gig if its going good and map out your end game out of medicine may up the savings or investing for a few years.

Yeah the job has other qualities that are good. Don’t see better options unless I open my own practice. Wish I would’ve been warned about this. If you’re smart enough to be a doctor and you want to make money so many better ways to do it. Sadly I can’t live like a resident I have two kids. If I was single I would definitely be doing the fire lifestyle and exiting after a few years.

 

[finalpsychyear]

Yeah the job has other qualities that are good. Don’t see better options unless I open my own practice. Wish I would’ve been warned about this. If you’re smart enough to be a doctor and you want to make money so many better ways to do it. Sadly I can’t live like a resident I have two kids. If I was single I would definitely be doing the fire lifestyle and exiting after a few years.

I spend about 2-3 hrs a day learning/reading/watching financially relevant things. I almost went to business school after medical school so i have a natural interest in that area. That's my best advice to others to learn the knowledge of the financial world asap and early as possible. Its not very complex compared to medical school but takes some time and interest which docs may not have cause they have to do notes and other after hours non sense and don't have the brain power to add that to the list. The system is designed to want us to work for as long as possible if we become "self aware" a la financially independent.... its no bueno for the system so its conveniently left out of all the training steps we do.

Financial wisdom is the key out of the golden handcuffs.

 

[Attending1985]

Follow up question. If this pay decrease was instituted a year ago and I was never told about it which my manager admitted to me in an email is this some sort of breach of contract?

 

[shoenberg3]

Just a lowly resident here, but can someone please reconcile the contrasting attitudes regarding the psychiatry job market?

On one hand, I often hear about plethora of job opportunities and rising salaries in psychiatry. On other hand, such as in thread, there only appears to be doom and gloom, with midlevel encroachment and decreasing reimbursements.

 

[Attending1985]

Follow up question. If this pay decrease was instituted a year ago and I was never told about it which my manager admitted to me in an email is this some sort of breach of contract?

Just a lowly resident here, but can someone please reconcile the contrasting attitudes regarding the psychiatry job market?

On one hand, I often hear about plethora of job opportunities and rising salaries in psychiatry. On other hand, such as in thread, there only appears to be doom and gloom, with midlevel encroachment and decreasing reimbursements.

Here’s my take. There’s never ending jobs but very limited high quality jobs. When I say that I mean good pay, autonomy, little call, good colleagues and admin.

 

[clausewitz2]

Follow up question. If this pay decrease was instituted a year ago and I was never told about it which my manager admitted to me in an email is this some sort of breach of contract?

You are going to want to have a lawyer look very carefully at your contract but this does not sound good for them. Save that email, print out a hard copy, document, document, document.

 

[PsyDr]

Yes but most aren't self employed to take advantage of DB, 401k, hsa let alone the higher level vehicles you have posted. Old surgeons were making 7 figs and the smart ones kept a lot of it due to what you mentioned albeit with a much higher irs audit risk back then let alone now going forward.

You can use various tools to scale, and in different settings. There is nothing illegal about using those tools.

The tools you are mentioning are not what I am referring to. If you look at a can of Coca Cola, you'll see it's partially an LLC. So are many media production companies. They all pay "distribution" companies the majority of their profits, and then reducing their tax liability to dividends. Many FLPs do that.

 

[Sanman]

Yeah the job has other qualities that are good. Don’t see better options unless I open my own practice. Wish I would’ve been warned about this. If you’re smart enough to be a doctor and you want to make money so many better ways to do it. Sadly I can’t live like a resident I have two kids. If I was single I would definitely be doing the fire lifestyle and exiting after a few years.

You don't need to live like a resident, you just can't live quite like a doctor. Plenty of folks get by on less and live a nice life.

 

[Stagg737]

Follow up question. If this pay decrease was instituted a year ago and I was never told about it which my manager admitted to me in an email is this some sort of breach of contract?

Depends. Does it say in the contract they can adjust your wages without informing you? If it does then it's obviously not. If it doesn't then I agree with Clause that it could be trouble for them. Worth speaking to a lawyer about if it's any significant amount of money.

You don't need to live like a resident, you just can't live quite like a doctor. Plenty of folks get by on less and live a nice life.

This. Most residents are going to make almost as much or more than the average American. Only difference is the average person doesn't have $200k+ in debt from med school. I think a lot of doctors either lose that perspective or never had it to begin with and I always roll my eyes a little bit about people complaining that they won't make $400k/yr without working hard.

 

[Sanman]

Just a lowly resident here, but can someone please reconcile the contrasting attitudes regarding the psychiatry job market?

On one hand, I often hear about plethora of job opportunities and rising salaries in psychiatry. On other hand, such as in thread, there only appears to be doom and gloom, with midlevel encroachment and decreasing reimbursements.

Here’s my take. There’s never ending jobs but very limited high quality jobs. When I say that I mean good pay, autonomy, little call, good colleagues and admin.

This depends on who you are, IMO. Plenty of psychiatrists and other mental health professionals running a small PP, out of network, dealing mostly with out of pocket clients/ higher SES. Taking insurance in network or a just a w-2 job at a larger provider is a different market. Depends on where you are located and what you want (and can afford) to do.

 

[Candidate2017]

The unrealized capital gains proposal is to garner lower to middle class votes. There are probably very few American individuals with $100 mm in their name, except for recent Powerball winners. Anyone with that much money has professionals setting up offshore trusts, etc.

Yeah the job has other qualities that are good. Don’t see better options unless I open my own practice. Wish I would’ve been warned about this. If you’re smart enough to be a doctor and you want to make money so many better ways to do it. Sadly I can’t live like a resident I have two kids. If I was single I would definitely be doing the fire lifestyle and exiting after a few years.

Even in psychiatry, one of the lowest paid specialties, we have the ability in the U.S. to generate capital by simply trading more labor. Whereas a salaried engineer or teacher will make the same whether they work 40 hours or 80 hours. If a young attending didn't go nuts on student loans or spend money like a drunken surgeon, it should be relatively quick for them to generate an amount of capital that will snowball into creating more income through that initial capital.

 

[Mad Jack]

Declining pay hurts.
Inflation is real, and actively underway. It hurts purchasing power and one's livelihood.
Talking points with current politicians can become real policies.
A real threat, is something such taxing unrealized gains, which could gut the entire retirement system.
Currently we have limited number of boomers and other generations financially prepared to embark into retirement with quality or even a glint of financial security.
Now, even considering or talking about taxing unrealized gains, would diminish retirement accounts even further. Diminish investment accounts, some people have those as an element of their retirement, too. Depending on how this policy is implemented or defined, it could even mean homes - the main investment for most people - image also getting taxed increased home valuations. The shear volume of ripples this would have in so many sectors of the economy is mind boggling. These points are all connected, and not just a random political insert. The grand theme, of decreased income directly, and other indirect means (inflation, government policy).

The previous thread was a simple query, are conservative student and residents discriminated against. That was it. Even a simple thread as that couldn't go unaccosted by vitriol of liberal posts.

My comments are a counter balance to heavy over vocalization of liberal views. If you'd like, I can use your label of "Inflammatory political content" each time I spot the similar on SDN from the majority opinions?

Or perhaps, you could educate me on the unrealized gains tax policy, and respond this way:
Yo Sushi. Definitely, face value, looks atrocious. But digging into the weed and details of what's proposed it might have merits as it would work like XYZ, and impact ABC. The ripple would be minimal. And likely not generate as much tax to make a government impact. But certainly is a good talking point in this political season to drum up more liberal support. Got to give cackling Kamala some credit there. So as of right now, thankfully, the odds of a greater US economic collapse are quite low, and we won't have to be worrying about the calculus of can we simply buy food. But can you imagine if Trump is able to cut taxes more with existing government expenditures how much that will drive up the national debt and possibly force an economic collapse with Greek level austerity measures in coming decades. Yikes!

Nah, I'll try to be civil and address the points in threads for the value of their ideas, and not attack the posters.

You do realize that those proposals are focused on people with 50-100 million dollars invested, at a minimum. It's not hitting your average boomer. And the increased capital gains rate is only set to target those making over a million dollars a year after deductions.

 

[Mad Jack]

Yeah the job has other qualities that are good. Don’t see better options unless I open my own practice. Wish I would’ve been warned about this. If you’re smart enough to be a doctor and you want to make money so many better ways to do it. Sadly I can’t live like a resident I have two kids. If I was single I would definitely be doing the fire lifestyle and exiting after a few years.

There's opportunities in psych to pull 450k+ per year, and even with two kids expenses are only high if you make them such. I would look more at what you can change to make your desired life possible versus the reasons it can't happen, if financial freedom is the goal. Whether the trades to get there are worth it, only you can answer

 

[J ROD]

Yeah I got hit with the updated WRVU so need to cut down conversion rate as well. I think I calculated out I need to see 1.5 patients more per day to make the same pay. Not happy about it but I get a 4 day work week and pay is still good. Generally let alone and good practice manager. Part of being a widget in a system. Private practice without insurance to me would be the only way out. Or do something else.

 

[annoyedpsychiatrist]

I work for a hospital system and make salary. My base salary has been the same for past few years, but given how many wrvus i generate and the state i work in, still pretty reasonable so im not upset about it. I like that my salary isnt tied to production which is nice. Especially because I get a ton of high acuity/low compliant pts, inappropriate referralls, and silly ADHD evals. But my bonus is tied to patient satisfaction...so either way, pick your poison sorta deal, lol.

 

[Stagg737]

I get a ton of high acuity/low compliant pts, inappropriate referralls, and silly ADHD evals. But my bonus is tied to patient satisfaction

Yikes, that seems like a recipe to either be a vending machine or potentially lose out on a lot of a bonus.

 

[sloh]

I work for a hospital system and make salary. My base salary has been the same for past few years, but given how many wrvus i generate and the state i work in, still pretty reasonable so im not upset about it. I like that my salary isnt tied to production which is nice. Especially because I get a ton of high acuity/low compliant pts, inappropriate referralls, and silly ADHD evals. But my bonus is tied to patient satisfaction...so either way, pick your poison sorta deal, lol.

You’re happy about base salary not rising with inflation?

 

[the5thelement]

This is simply preposterous. Everything costs 50% more. Is the CEO also taking a paycut?

 

[annoyedpsychiatrist]

Yikes, that seems like a recipe to either be a vending machine or potentially lose out on a lot of a bonus.

You’re happy about base salary not rising with inflation?

stagg: you are absolutely right. luckily its not 100% of my bonus, but does affect 10% which is still annoying but whatever i suppose.

sloh: for now yeah. My base salary with the bonus is still pretty competitive, combined with no state tax. My work schedule i do see challenging pts, but have a very reasonable schedule/hours. Im still making around the average psych salary, but my day is not overly intense most of the time. I also have strong support staff here and good colleagues. Also i technically only have roughly 2.5 years of pslf left, so thats the biggest value for me. I think after i get pslf ill evaluate things further and see what i think